Medical Specialties Commons^™

Program Evaluation Intensive: Practical Training In Selecting Measures And Data Collection Methods To Obtain Useful Outcome Data, Robyn Shepherdson, Jennifer Funderburk, Nadiya Sunderji, Nadiya Sunderji, Jodi Polaha

ETSU Faculty Works

Do you need help determining appropriate measures and feasible data collection methods for program evaluations within integrated primary care? In this 3-hour preconference workshop, leaders from CFHA’s Research & Evaluation Committee and Families, Systems, & Health journal will provide practical training in conducting rigorous program evaluations. This workshop will help you identify appropriate measures to answer your key questions as well as data collection methods that balance quality and feasibility. This workshop is designed for those who are planning, conducting, or revising a program evaluation, as attendees will apply the material to their own personal projects within interactive small groups.

Evaluation Of Intervention Aimed At Reducing Alteplase Returns Without Compromising Clinical Care In Acute Ischemic Stroke, Natalie Swearingen, Jillian Myers, Alyx Lesko, Lindsay Lucas, Elizabeth Baraban

Articles, Abstracts, and Reports

No abstract provided.

A Comparative Study On Mental Health Knowledge Based On Socioeconomic Status In Kisumu Kenya 2019, Mashoud Kaba

Independent Study Project (ISP) Collection

Studies show that people who live in rural Kenya have more positive attitudes toward mental illnesses than people in urban areas. They also had more mental health knowledge. One of the differentiating factors between the two environments is the socioeconomic status of those who live in each area. People in rural areas tend to be of lower socioeconomic status, while those living in urban areas tend to be of a higher socioeconomic status. I wanted to see if the previous findings would be observed if we were looking at people in the same area (strictly urban or rural) with the …

Socio-Cultural Norms And Perceptions Of Menstruation: An Intergenerational Analysis Of Rural Jamkhed, Maharashtra, Addison Scales

Independent Study Project (ISP) Collection

This study analyzes the socio-cultural norms and perceptions of menstruation between two generations of women in rural Jamkhed, Maharashtra. Interview questions were prepared for women between the ages of 18-26 and 35 or older to determine the level of dilution of the menstrual taboo and stigmas between age groups. All women resided in two villages in the rural area surrounding Jamkhed, Maharashtra. A variety of socio-cultural perceptions and practices were explored to determine their correlation with external influences on the shifting menstruation narrative. The socio-cultural factors of focus are family structure, media exposure, choice of material use, disposal and sustainability, …

Vital Signs, Fall 2019, Boonshoft School Of Medicine

Vital Signs

A thirty-two page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, alumni profiles, class notes, and more.

Antibiotic Treatment Of Suspected And Confirmed Neonatal Sepsis Within 28 Days Of Birth: A Retrospective Analysis, Jadon S. Wagstaff, Robert J. Durrant, Michael G. Newman, Rachael Eason, Robert M. Ward, Catherine M.T. Sherwin, Elena Y. Enioutina

Pediatrics Faculty Publications

Neonatal sepsis causes significant mortality and morbidity worldwide. Diagnosis is usually confirmed via blood culture results. Blood culture sepsis confirmation can take days and suffer from contamination and false negatives. Empiric therapy with antibiotics is common. This study aims to retrospectively describe and compare treatments of blood culture-confirmed and unconfirmed, but suspected, sepsis within the University of Utah Hospital system. Electronic health records were obtained from 1,248 neonates from January 1, 2006, to December 31, 2017. Sepsis was categorized into early-onset (≤3 days of birth, EOS) and late-onset (>3 and ≤28 days of birth, LOS) and categorized as culture-confirmed …

Implementing Treat To Target Approach In The Care Of Children With Juvenile Idiopathic Arthritis, Julia G. Harris, Jamie Holland, Emily Fox, Leslie Favier, Ashley M. Cooper

Posters

Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory disease seen in pediatric rheumatology. Despite advances in biologic therapy, many children with JIA will experience morbidity. Treat to Target is a treatment paradigm that involves setting a target of disease activity, using shared decision making, and incorporating clinical decision support. Our clinic aimed to set a treatment target on 50% of eligible JIA patients by December 31, 2019.

Improving Care Of The Small Baby, Beckie Palmer, Abdebayo Oshodi, Brandy Huitt, Kaylee Hurt, Pamela Kliethermes, Trudy Koons, Patricia Lanzer, Ashley Mirabile, Allyson Owen, Christian Anthony Schneider, Betsi Anderson, Steven Olsen

Posters

Hierarchy of Aims:

• Global Aim: Create a Small Baby Unit for infants admitted to our NICU that arebirth, in which 90% of our patients are admitted to F pod on day of admission, by March 2019
• Interim Aim: Staff 80% of our micropremie patients with a Small Baby Team nurse from admission until >32 weeks by May 2019.
• Sub Aim: Increase rates of developmentally appropriate care (2 person cares, kangaroo care compliance) by 50% by August 2019.

Increasing Kangaroo Care In A New Small Baby Unit, Dianne Wilderson, Barb Haney, Ashley Mirabile, Beckie Palmer, Jenny Heltzer, Erin Keith-Chancy Bsn,Ccrn, Brooke Smith, Christian Anthony Schneider, Abdebayo Oshodi

Posters

Project Aim: Increase the percent of eligible patients receiving kangaroo care from 19% to 30% by September 2019.

Results:

113 staff completed education

OT consults completed on all SBU patients

20 kangaroo wraps purchased

Kangaroo care rate in NICU increased from 19% (prior to SBU) to 36% (Post SBU opening).

Conclusion: Due to increased multidisciplinary awareness of importance of kangaroo care in the SBU more parents are completing kangaroo care.

A Paramedic Staffed Prehospital Program May Reduce Hospital Readmissions For Heart Failure, Bruce Feldman Do, Christopher J. Greb Nrp, Orlando E. Rivera Rn, Mahek Shah Md, Jennifer Nesfeder, Deborah W. Sundlof Do, Nael Hawwa Md, Alma N. Ohl Crnp, Tara K. Henry-Morrow Emt-P, Jeanne L. Jacoby Md

Department of Emergency Medicine

No abstract provided.

Burden And Risk Of Neurological And Cognitive Impairment In Pediatric Sickle Cell Anemia In Uganda (Brain Safe): Final Results Of The Cross-Sectional Analysis, Nancy Green, Deogratias Munube, Paul Bangirana, Linda Buluma, Bridget Kebirungi, Robert Opoka, Ezekiel Mupere, Philip Kasirye, Sarah Kiguli, Annet Birabwa

Paediatrics and Child Health, East Africa

Background: Children with sickle cell anemia (SCA) are highly susceptible to stroke and other manifestations of pediatric cerebral vasculopathy. Detailed evaluations in sub-Saharan Africa are limited.

Methods: We aimed to establish the frequency and types of pediatric brain injury in a cross-sectional study at a large SCA clinic in Kampala, Uganda in a randomly selected sample of 265 patients with HbSS ages 1–12 years. Brain injury was defined as one or more abnormality on standardized testing: neurocognitive impairment using an age-appropriate test battery, prior stroke by examination or transcranial Doppler (TCD) velocities associated with stroke risk in children with …

Intestinal Permeability And Inflammation Mediate The Association Between Nutrient Density Of Complementary Foods And Biochemical Measures Of Micronutrient Status In Young Children: Results From The Mal-Ed Study, Benjamin J J. Mccormick, Laura E. Murray-Kolb, Gwenyth O. Lee, Kerry J. Schulze, A Catharine Ross, Aubrey Bauck, Aldo A M. Lima, Bruna L L. Maciel, Ali Turab, Zulfiqar Ahmed Bhutta, Mal-Ed Network Investigators, Shahida Qureshi, Muneera Rasheed, Sajid Bashir Soofi, Anita K. M. Zaidi

Woman and Child Health

Background: Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation.
Objective: We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status.
Methods: Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We …

Global Burden Of Atherosclerotic Cardiovascular Disease In People With Hepatitis C Virus Infection: A Systematic Review, Meta-Analysis, And Modelling Study, Kuan Ken Lee, Dominik Stelzle, Rong Bing, Mohamed Anwar, Fiona Strachan, Sophia Bashir, David E. Newby, Jasmit Shah, Michael Chung, Gerald S. Bloomfield

Internal Medicine, East Africa

Background: More than 70 million people worldwide are estimated to have hepatitis C virus (HCV) infection. Emerging evidence indicates an association between HCV and atherosclerotic cardiovascular disease. We aimed to determine the association between HCV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HCV.

Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, Ovid Global Health, and Web of Science databases from inception to May 9, 2018, without language restrictions, for longitudinal studies that evaluated the risk ratio (RR) of cardiovascular disease in people with HCV compared with those without …

Socioemotional Selectivity And Psychological Health In Amyotrophic Lateral Sclerosis Patients And Caregivers: A Longitudinal, Dyadic Analysis, Suzanne C. Segerstrom, Edward J. Kasarskis, David W. Fardo, Philip M. Westgate

Psychology Faculty Publications

Objective: Socioemotional selectivity theory predicts that as the end of life approaches, goals and resources that provide immediate, hedonic reward become more important than those that provide delayed rewards. This study tested whether these goal domains differentially affected psychological health in the context of marital dyads in which one partner had been diagnosed with amyotrophic lateral sclerosis (ALS), a life-limiting disease.

Design: ALS patients (N = 102) being treated in three multidisciplinary clinics and their spouses (N = 100) reported their loneliness, financial worry and psychological health every 3 months for up to 18 months.

Main …

Understanding Young Adult Survivors Of Childhood Cancers’ Participation In Late Effects Screening: A Mixed Methods Approach, Kristen Trost Mantlo

Health Services Research Dissertations

Significant advancements in the treatment of childhood cancers have helped to increase the 5-year survival rate from 56% in the early 1970s to approximately 80-85% in the early 2000s (Greenlee, Murray, Bolden, & Wingo, 2000; Hampton, 2005). Treatment modalities such as chemotherapy and radiation have led to many serious long-term side effects, known as late effects. Between 60% and 90% of survivors develop some form of long-term chronic condition due to their treatment and up to 40% of those conditions will be life-threatening (Howlader, N. et al., 2013). While the majority of young adult survivors of childhood cancer are at …

Revisiting The Expanded Use Of Hyperbaric Oxygen Therapy For Treatment Of Resistant Migraines, David V Matera, Brian Smith, Benjamin Lam

PCOM Scholarly Works

There are currently 13 indications approved by the U.S. Food and Drug Administration for use of hyperbaric oxygen therapy. The European Consensus Conference on Hyperbaric Medicine has 28 indications approved for its use. However, neither includes the use of hyperbaric oxygen therapy for neurological conditions such as migraines with aura. Recent research has made the attempt to fully understand the use of hyperbaric therapy in treatment of neurological conditions, but results have so far been inconclusive. We report a 23-year-old female with an 11-year history of migraines with aura who has received inadequate pharmacological treatment for her migraines since she …

It’S Not Always Occam's Razor – The Case Of A Young Man With Subaortic Membrane With Superimposed Pulmonary Thromboembolism And Left Main Coronary Artery Disease, Hunaina Shahab, Abdul Baqi, Yusra Askari, Qurrat Ul Ain Aqeel, Kumail Khandwala

Section of Cardiology

Subaortic membrane (SAM) is a discrete fibromuscular structure which causes left ventricular outflow tract obstruction and leads to the symptomatology of valvular aortic stenosis. It is known to be associated with other congenital cardiac defects in around 30% of cases. However, it has not been associated with chronic pulmonary thromboembolism in the past. We present a case of a middle-aged Pakistani man who presented with dyspnea and hemoptysis. He was found to have a SAM and severe pulmonary hypertension on transthoracic echocardiogram. A coronary angiogram revealed non-obstructive left main coronary artery disease. A computed tomography (CT) scan chest was done …

Labrad : Vol 45, Issue 3 - October 2019, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Therapeutic Drug Monitoring for Antibiotics in Infections
• Biomarkers of Sepsis
• Serum Procalcitonin Level - Marker of Bacterial Infection
• Bone Marrow Findings in Malaria
• Antibiogram: A Clinicians’ Reference for Antibiotic Selection
• Laboratory Diagnosis of Meningitis
• Detection of Pneumocystis Jirovecii by PCR
• Microbiology Quiz
• Radiology Pathology Correlation- Orthopedic Pathology
• Role of Imaging in the Diagnosis and Management of Hepatic Abscess
• The Best of the Past
• Microbiology Quiz’s Answer
• Polaroid

Predictors For Expired Co2 In Neonatal Bag-Mask Ventilation At Birth: Observational Study, Kari Holte, Hege Langli Ersdal, Joar Eilevstjønn, Monica Thallinger, Jørgen Linde, Claus Klingenberg, Rene Holst, Samwel Jatosh, Hussein Kidanto, Ketil Stordal

Obstetrics and Gynaecology, East Africa

Background: Expired carbon dioxide (ECO2) indicates degree of lung aeration immediately after birth. Favourable ventilation techniques may be associated with higher ECO2 and a faster increase. Clinical condition will however also affect measured values. The aim of this study was to explore the relative impact of ventilation factors and clinical factors on ECO2 during bag-mask ventilation of near-term newborns.

Methods: Observational study performed in a Tanzanian rural hospital. Side-stream measures of ECO2, ventilation data, heart rate and clinical information were recorded in 434 bag-mask ventilated newborns with initial heart rate <120 beats per minute. We studied ECO2 by clinical factors (birth weight, Apgar scores and initial heart rate) and ventilation factors (expired tidal volume, ventilation frequency, mask leak and inflation pressure) in random intercept models and Cox regression for time to ECO2 >2%.

Results: ECO2 rose non-linearly with increasing expired tidal volume …

Big Spine Data Put To Good Use: The Nhs Sets An Example., Jens R Chapman, Jeffrey C Wang, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Hemostatic Complications Associated With Ventricular Assist Devices., Talal Hilal, James O Mudd, Thomas G Deloughery

Articles, Abstracts, and Reports

Hemostatic complications are common in patients with ventricular assist devices. The pathophysiologic mechanisms that lead to dysregulated hemostasis involve complex interactions between device surface, sheer stress, and blood flow. These factors lead to various manifestations that require a thorough understanding of the interplay among platelets, coagulation factors, and red cells. In this article, we review the pathophysiology of hematologic complications (bleeding, acquired von Willebrand disease, heparin-induced thrombocytopenia, hemolysis, stroke and pump thrombosis), the clinical manifestations, and the management of each. We summarize the evidence available for management of these entities and provide a pragmatic clinical review.

Hyperbaric Oxygen Therapy: Effect On Wound Healing And Traumatic Brain Injuries, Sara L. Seuffert

Student Publications

Hyperbaric Oxygen Therapy is a new form of treatment being used to heal and help improve symptoms of traumatic brain injuries, external wounds, and strokes. HBOT helps to completely saturate hemoglobin with oxygen, which then allows for a larger capacity of oxygen to be delivered to the damaged tissues. Tissue wounds benefit from this HBOT because of the increase in oxygen supply to the damaged area, helping to combat hypoxia, which is preventing proper wound healing. The increase in oxygen allows for an increase in myofibroblast differentiation to allow the healing process to continue. HBOT has also proven to increase …

A Comprehensive Rehabilitation Program For Treating Lateral Elbow Tendinopathy, Joseph M. Day, Ann M. Lucado, Timothy L. Uhl

Physical Therapy Faculty Publications

Scapular muscle weakness in patients with lateral elbow tendinopathy is an identified impairment and is part of a multimodal rehabilitation approach. The published literature provides little information regarding specific rehabilitation guidelines that address both the proximal scapular muscle weakness and local elbow/ wrist dysfunctions common in patients with lateral elbow tendinopathy. The purpose of this clinical commentary is to describe a comprehensive rehabilitation strategy for individuals with lateral elbow tendinopathy. This program emphasizes a phased therapeutic strategy that addresses proximal and local dysfunction along the kinetic chain. This clinical protocol is currently being tested for efficacy as part of a …

Radical Hysterectomy For Operable Early Cervical Cancer In Hiv-Positive And Hiv-Negative Women In Western Kenya, Peter M. Itsura, Rachel N. Deraney, Elkanah Omenge, Philip Tonui, Barry Rosen, Susan Cu-Uvin

Obstetrics and Gynaecology, East Africa

Radical hysterectomy is well tolerated with no increase in complications in HIV-infected women and is an appropriate form of treatment for early-stage cervical cancer in HIV-infected women.

The Write Stuff - Autumn 2019 (Vol.16, No.4), Research Medical Library

Write Stuff 2019

• Scientific Publications and the Research Medical Library join forces, expand services
• Incorporating sex as a biological variable in NIH grant applications
• Hyperlinks in NIH grant applications
• Altmetrics: Looking beyond citation analysis to measure impact
• Guidelines for reporting your research methods to improve reproducibility and rigor
• Unusual terms used in scientific writing and publishing: Core Grant

"Will Using Telemedicine With Medical Command During Situational Awareness Escalation Add Value To Patient Care?", Kathy Farrell, Bradley Bishop, Lisa Carney, Matthew B. Johnson, Natalie Masters, Lisa Pruitt, Sherry Mccool, Laura Fitzmaurice

Posters

No abstract provided.

Making The Management Of Acute Otitis Media A Snap, Cassandra Newell, Donna Wyly, Tanis Stewart, Alaina N. Burns, Brian R. Lee, Rana El Feghaly

Posters

AIM:

To improve Watchful Waiting or Safety Net Antibiotic Prescription (WW/SNAP) in children >6 months old diagnosed with acute otitis media by Advanced Practice Nurses in the Emergency Department by May 2020.

Optimizing Antibiotic Management Of Pediatric Acute Otitis Media In An Emergency Department, Alicia Daggett, Alaina N. Burns, Brian R. Lee, Nirav Shastri, Patricia Phillips, Rana E. El Feghaly

Posters

Problem

Children diagnosed with acute otitis media (AOM) at the Children's Mercy Hospital Kansas Emergency Department routinely get antibiotic prescriptions. There is rarely discussion with families about watchful waiting (defined as discussion of observation with parents and providing a safety-net antibiotic prescription that parents can ill if the patient is not improving or is worsening over the next 48 hours).

The aim of this quality improvement project is to increase watchful waiting for AOM at the CMK ED by 20% by March 2020, with an overall goal of decreasing antibiotic use for AOM.

Collaboration Between Rheumatology Clinic And Specialty Pharmacy To Positively Impact Patient Experience And Hospital Stewardship, Alaina Linafelter, Julia G. Harris, Robert Herr, Stephanie Quinn, Ashley M. Cooper

Posters

Biologic medications are commonly utilized to treat pediatric rheumatic diseases. Being high-cost, most third-party payers require dispensing through a specialty pharmacy. Children's Mercy Hospital Specialty Pharmacy (CMH SP) started acceting patients in March 2015.

The number of patients benefited by the superior service of CMH SP has risen steadily, leading to high patient satisfaction and financial benefits for the hospital.

Safe Sleep In The Nicu, Ashley Mirabile, Barb Haney, Dianne Wilderson, Beckie Palmer, Ashley Domsch, Eugenia K. Pallotto

Posters

Goal: To evaluate a staff education program on approach to improve in the rate of eligible NICU infants in safe sleep in a busy 84-bed level IV NICU.

Outcome Measures; Improve safe sleep compliance for eligible patients to 90% or greater by December 2019.

Process Measures: Audits from bedside RNs showing compliance with safe sleep.

Planned Intervention: In December of 2018 a multidisciplinary work group brainstormed and implemented best practice safe sleep education for staff and parents. September 2019 a Safe Sleep Educational Toolkit was made available for staff.

Results: Safe Sleep compliance has gone from 53% to 90% in …